Health Challenges and Opportunities for an Aging China

If there is an issue of concern to all nations of the world in the past, present, and future, it is population aging. The most populous nation in the world, China also has the largest elderly population. There were 143.9 million elderly adults (aged 65 years or older) living in China at the end of 2015, accounting for 10.5% of the total population.¹ China’s older population is larger than the sum of the elderly populations of European nations.

China is also one of the nations where population aging is taking place most rapidly. In 2000, the percentage of the population aged 65 years or older in China reached 7%, and, according to estimates, it will take only 26 years to double this percentage to 14%.² By contrast, the same rise required 115 years in France and 85 years in Sweden.² The old-age dependency ratio in China has reached 14.3%, indicating substantial social and family burdens. The significant numbers of older adults, as well as their health, living conditions, social security status, and support networks, are matters of great concern to the government and to families.

At the same time as this demographic transition, China has been undergoing rapid social, economic, and institutional changes. Since the Chinese economic reform of the late 1970s and 1980s, advances in medicine and technology have helped lead to an increase in the life expectancy of the Chinese population (from 67.8 years in 1981 to 76.3 years in 2015).¹ Moreover, the age-standardized death rate among older adults decreased from 45.8 per 1000 population in 2005 to 31.2 per 1000 in 2015.¹

However, the main causes of death among older adults have not changed significantly. As shown in Figure 1, noncommunicable diseases—such as diseases of the circulation system, diseases of the respiratory system, and neoplasms—and injuries, poisonings, and consequences of external causes are still the main killers of older individuals in China.

FIGURE 1—

Disease-Specific Age-Standardized Mortality Rates Among Older Adults: China, 2005 and 2015

Note. Rates are per 100 000 population. Data were derived from the National Bureau of Statistics China.¹

PHYSICAL AND MENTAL DISABILITY CHALLENGES

Notwithstanding declines in mortality, global aging has a major influence on disability trends in the older population. In fact, as advances in medical technology prolong life spans and decrease mortality, disability has become a global challenge in terms of the health of the elderly population. According to the World Health Organization, almost all individuals will experience a disability at some time in their lives, and it is likely that those who live longer will endure increasing difficulties in everyday physical and mental functioning.³

Estimates indicate that more than 1 billion people worldwide are living with some form of disability that affects their daily lives and social activities.³ A pair of large-scale, nationally representative household surveys conducted in China indicate that 38.3 million of the country’s elderly residents had a disability in 2006, more than twice the number in 1987 (16.7 million).⁴ According to our predictions, this figure will reach 115 million in 2050.⁵ Fifty percent of people with disabilities were aged 65 years or older in 2006, and almost 30% of older adults with disabilities had profound or severe disabilities.⁴ However, the annual rate of treatment and rehabilitation service use (in combination) among disabled older adults is still quite low, although the rate increased from 8.2% in 2007 to 18.7% in 2013, according to surveillance survey data.⁶

Moreover, it is noteworthy that forms of disability among older individuals have changed, with significant increases in the prevalence of motor disabilities (from 2.56% in 1987 to 6.71% in 2006) and mental disabilities (from 0.26% to 0.63%).⁴ These increases are partly attributable to an epidemiological transition from communicable diseases toward noncommunicable diseases, injuries, and mental disorders. Another finding of note is that a substantial proportion of the older population is living with more than one type of disability. As the population ages further, increasingly higher numbers of older adults will be at risk for multiple disabilities.

The development of the biopsychosocial model has led to physical health and mental health being inextricably linked, and the tenets of the model have proven to hold true for disabilities. In 2006, elderly individuals with motor disabilities were 2.11 times (95% confidence interval [CI] = 1.89, 2.35) more likely to have a comorbid mental disability than those without motor disabilities.⁴ Unexpectedly, factors such as higher household incomes, residence in urban areas, and residence in the country’s eastern region were also associated with a higher risk of comorbid mental disabilities.

In that same year, the risk of mental disability was 1.86 times (95% CI = 1.23, 2.81) higher when individuals with motor disabilities were diagnosed while they were members of the labor force than when they were diagnosed at the age of 65 years or older.⁴ Generally, people are most active in terms of social production during the period in which they are participants in the labor force, and thus motor disabilities diagnosed during this period may have a greater impact on their mental health, resulting in comorbid mental disabilities.

As China is undergoing social reform, these findings highlight the need for implementing more comprehensive prevention and rehabilitation strategies. These strategies will support not only older adults themselves but also current labor force participants.

HEALTH FOR EVERYONE AT ALL AGES

Aging and disability are not only issues for the elderly population. Higher morbidity or disability rates among older people reflect an accumulation of health risks across the life span. Currently, the Chinese government is developing Healthy China 2030 as a national strategy.⁷ The plan is a general guideline for promoting health in the coming 15 years. Health promotion for the entire population and throughout the life cycle is the primary theme, and older adults and individuals with disabilities are two of the key target populations. This strategy will provide great opportunities to engage in research and practice with respect to health and disability among older adults, as well as policy-making in terms of prevention and rehabilitation.

In conclusion, global aging, as an embodiment of the progress of human society and civilization, brings both challenges and opportunities. China is fully aware of its responsibilities and mission in population health and sustainable human development, as evidenced in Healthy China 2030. The next step is to implement specific proposals, comprehensive plans, and detailed measures to achieve the goal of active and healthy aging in China. Such activities will also contribute to population health across the Asia Pacific region and the world.